August briefing for all Sheffield pharmacy staff
- Methotrexate 10mg
Recently, a Sheffield patient narrowly avoided taking a dangerous dose of methotrexate after the 10mg tablets had been put on repeats instead of 2.5mg. Sheffield prescribing data is showing a steady increase in the use of methotrexate 10mg tablets, which is a worrying trend. Pharmacists presented with prescriptions for the 10mg strength should confirm with the patient that this is the strength they normally take.
Since Sheffield Teaching Hospitals do not stock the 10mg tablet all patient will have been initiated on the 2.5mg strength. However, some may wish to reduce their ‘tablet load’ and hence prefer to take, say, 2 X 10mg rather than 8 X 2.5mg. In such cases it may be appropriate to supply the higher strength. This is in accordance with an NPSA alert issued in June 2006.
This alert advised that the strength of tablet supplied to the patient must stay consistent to prevent any confusion about the number of tablets they need to take, and the patient’s monitoring document and Patient Medication Record should be checked to confirm the previous supply. The patient should be reminded about their dose in terms of quantity of tablets and weekly frequency. The patient should have received a monitoring booklet from STH. However, if this has been mislaid the patient should be advised to contact the specialist department for a replacement.
- Methotrexate and Trimethoprim Interaction
In another reported incident a Sheffield patient taking methotrexate was prescribed trimethoprim. Although I don’t have full details around this incident it is possible for a patient to seek out-of-hours treatment for a UTI and be prescribed trimethoprim or supplied with it through a PGD.
Patients should be aware that they need to inform any clinician managing their care that they are being treated with methotrexate. It would be helpful for pharmacists to reinforce this advice – perhaps reminding these patients until the end of October in order to catch them all.
- Methotrexate Day
For the period that patients are being reminded to tell any clinician that they are on methotrexate (previous item, above) please capture the actual day of the week that they take their dose. This should be recorded on the dispensing label and, if possible, remind the surgery to ensure the day of the week is also added to the directions on any future prescriptions. This action has been recommended by the Area Prescribing Group to reduce errors particularly if the patient is admitted into hospital or other care settings.
Patients should also be advised to take the folic acid as directed by the specialist.
- Smartcard Sponsors
I now understand that HSCIC have decided NOT to split the functions of Smartcard Sponsor and ID Checker and so sponsors will still be able to request a new smartcard for pharmacy staff through the Care Identity Service section of the NHS Portal.
However, there may be a small number of sponsors whose roles were changed before this decision was taken. If your rights to check IDs have been withdrawn please contact the RA by email ()
- Dispenser Smartcard Roles
Following a directive from HSCIC (now known as NHS Digital) the enabled roles for dispensers are being changed and the B0572 (Manage Pharmacy Activities) is being removed. Thus dispensers are now only able to access EPS to view and record dispensing activity under the supervision of a pharmacist. This change does not affect registered pharmacy technicians who are are still able to access all relevant EPS dispensing functionality.
The pharmacy sponsor may need to approve the addition of B0572 to the dispenser’s smartcard where they rely on the dispenser to manage claims for EPS prescriptions. This will be necessary in those pharmacies that do not employ a registered pharmacy technician.
- SCR Access
In common with other areas, pharmacies are still slow to make full use of access to Summary Care Records. The facility is there to be used and will help to make the correct decisions in many pharmacy activities, not just when dispensing. Responding to symptoms, EHC provision and emergency supplies are just some of the areas where accessing the patient’s record becomes useful. Feedback has highlighted that some pharmacy staff are wary of accessing records, fearing that they will fall foul of information governance issues. This is not the case. Access is appropriate provided that there is a clinical relationship with the patient and there is a reason to access the record.
Link to Pharmacy Resources
Community Pharmacy Lead Pharmacist
NHS Sheffield Clinical Commissioning Group
722 Prince of Wales Road
📞 Tel: 0114 305 1129